Painless dissecting aneurysm of the thoracic aorta: Report of eight cases masquerading as gross aortic insufficiency, severe hypertension, myocardial infarction and mediastinal enlargement.

In a review of 68 patients with dissecting thoracic aorta aneurysm (DTAA), eight patients (11.7%) were found to have painless dissection. Three of the eight patients presented with gross aortic insufficiency (Al). Angiography on a fourth patient, who had severe hypertension, showed Type III DTAA. Three other patients had either dilatation of the ascending aorta or a possible mediastinal mass, according to chest roentgenograms. One patient received treatment for suspected myocardial infarction with cardiogenic shock. A high index of suspicion in patients with unexplained Al, severe hypertension and a mediastinal mass or dilatation of the ascending aorta, coupled with the early use of angiographic studies, will assist in establishing the diagnosis and decide the most appropriate management